Background & Purpose: During the last decade, promoting cultural competence (CC) has been a priority for behavioral health agencies due to persistent racial and ethnic disparities in the access and utilization of services. Disparities are manifested in lack of access to services, differentials in treatment, and high termination rates among diverse populations. In evaluating CC training and education, the majority of studies have focused on provider level outcomes, rather than outcomes for persons-in-recovery (PIR). Further research is needed to examine how PIRs understand and experience CC in the treatment setting. This presentation will address how CC can be measured from the PIR perspective based on the experience of the statewide PRIME (Partners Reaching to Improve Multicultural Effectiveness) training for behavioral health professionals. The paper discusses the challenges in developing a quantitative evaluation design that captures PIR level outcomes.

Methods: Trainees identified PIRs on their caseload that differed from and were similar to them culturally and completed a demographic questionnaire with them. PIRs were contacted by a PIR on the evaluation team to complete a phone interview. PIRs responded to a 23-item scale assessing their provider's CC and answered questions about how their cultural identity related to their treatment. The variation in service setting, target population, duration of services, and provider role among the trainees challenged the evaluators to develop questions that were appropriate for all PIRs.

Results: Of the 69 PIRs selected for the study, only 32 PIRs completed the interview. Refusers tended to be younger than participants and have spent less time in behavioral health services. The majority of participants reported that having a provider of their ethnicity, culture or race was not important, and having their ethnicity, race and culture integrated into treatment was moderately important. Most rated their provider's cultural competency as good and were satisfied with services. No correlation was found between provider race, PIR race and satisfaction with services. Few responded to the concluding open-ended question, but the majority who responded expressed satisfaction with their provider.

Implications: Preliminary results indicate that PIRs targeted by the evaluation study do not consider the provider's race/ethnicity or cultural competency apart from other service-related factors and overall are satisfied with their services. One explanation is that existing measures do not adequately reflect how PIRs experience CC in their treatment, implying more research is needed to understand the PIR perspective of CC. Another explanation may be the sampling strategy did not reach the PIRs who experience barriers to services, possibly due to a lack of CC, as indicated by the study's high attrition rate. High termination rates found among diverse populations suggests that CC plays an important role during the engagement process, rather than once the provider-PIR relationship is established. Therefore, evaluation designs should target PIRs during engagement process and take steps to follow up with PIRs who drop out of services to assess the impact on CC of these aspects of service delivery.